High Therapeutic Efficiency with Ledipasvir/Sofosbuvir for the Treatment of Genotype 1 Chronic Hepatitis C in Portugal

Chronic hepatitis C (CHC) is a major public health problem affecting 1.5% of the Portuguese population and reducing life expectancy by 20 years. The most recent international guidelines recommend the utilization of sofosbuvir (SOF) as backbone for the treatment of CHC patients. The association of ledipasvir (LDV) to SOF enhances SOF efficacy and safety, especially in patients infected with genotype-1 hepatitis C virus. Additionally, it allows the treatment of CHC patients without using pegylated interferon-α (PegIFN) and ribavirin (RBV). The objective of this study was to estimate LDV/SOF’s contribution to the Portuguese public health by exhausting CHC therapeutic efficiency. Therapeutic efficiency was defined as maximum capacity to benefit from treatment in terms of life years (LY) relative to the general population’s life expectancy. The natural history of CHC and treatment implication was modelled with a Markov model allowing for long-term assessment in terms of HCV fibrosis progression. Comparators used were SOF+PegIFN+RBV, SOF+RBV, boceprevir+PegIFN+RBV and PegIFN+RBV, taking into consideration the therapeutic options currently financed by the Portuguese National Health System, the recommendation of SOF as the standard of care and the coincidence between therapeutic indications. In HCV genotype-1 non-cirrhotic patients, LDV/SOF treatment is estimated to result in 0.21 LY, 1.5 LY or 1.44-2.90 LY gained in comparison to SOF+PegIFN+RBV, SOF+RBV or the options financed by the Portuguese NHS, respectively; for patients with cirrhosis, these values are 1.20 LY, 4.08 LY or 1.33-4.67 LY, respectively. In patients infected with HCV genotype-1, LDV/SOF is expected to enhance life expectancy, with therapeutic efficiency ranging from 86.2% to 98.4%. LDV/SOF regimens are associated with high therapeutic efficiency, and are expected to maximize the years of life of the Portuguese genotype-1 HCV patients.